Obamacare: What's in place now – and working

At AltaMed in Garden Grove, pharmacy manager Tam Nguyen holds a prescription being filled. The nonprofit provider sees an average of 125 patients a day in Garden Grove, and aims to care for Latino, multi-ethnic and underserved communities in Southern California. JEBB HARRIS, ORANGE COUNTY REGISTER

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RN Supervisor Francisca Martinez is shown in the waiting room at AltaMed in Garden Grove. "AltaMed is prepared for the new Obamacare and health care reform," she said. "The plan is in alignment with our mission statement which is to serve the underserved regardless of their pre-existing conditions and income." JEBB HARRIS, ORANGE COUNTY REGISTER

At AltaMed in Garden Grove, Dr. Jimmy Wu examines patient Yolanda Flores, 87. The nonprofit provider, which sees an average of 125 patients a day in Garden Grove, aims to care for Latino, multi-ethnic and underserved communities in Southern California. JEBB HARRIS, ORANGE COUNTY REGISTER

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At AltaMed in Garden Grove, pharmacy manager Tam Nguyen demonstrates a Parata automated pill counter which saves time in filling a high volume of prescriptions. JEBB HARRIS, ORANGE COUNTY REGISTER

At AltaMed in Garden Grove, Dr. Jimmy Wu talks medicines with patient Yolanda Flores, 87. The nonprofit provider sees an average of 125 patients a day in Garden Grove. JEBB HARRIS, ORANGE COUNTY REGISTER

RN Supervisor Francisca Martinez greets patients in the waiting room at AltaMed in Garden Grove. "AltaMed is prepared for the new Obama Care and Health Care Reform. The plan is in alignment with our mission statement which is to serve the underserved regardless of their pre-existing conditions and income," she said. The nonprofit provider, which sees an average of 125 patients a day in Garden Grove, aims to care for Latino, multi-ethnic and underserved communities in Southern California. JEBB HARRIS, ORANGE COUNTY REGISTER

Why it matters

The core provisions of the federal health overhaul known as the Affordable Care Act take effect on Jan. 1, when most Americans will be required to have health insurance and subsidies will be available for those who cannot afford it. But many parts of the law have been in effect for nearly three years, and millions of Californians are already benefiting from the changes.

More to come

Watch for these stories in the coming weeks.

Risky business: How the Affordable Care Act changes the fundamental assumption at the heart of health insurance.

Medi-Cal expansion: Nearly one in four Californians will soon be receiving health care through the state-run Medi-Cal program.

Readers: Send questions about Obamacare to Emily Bazar, who writes the Ask Emily column for the Register, at AskEmily@usc.edu. Suggestions for Register coverage can go to editors Mark Matassa (mmatassa@ocregister. com) or Dan Beucke (dbeucke@ocregister.com).

Who's already benefiting

435,000

Estimated number of young adults who have coverage under the law's requirement that insurers allow adult children to remain on their parents' policies through age 26

700,000

Number of low-income Californians who have coverage under a transition program to the Affordable Care Act's expansion of Medi-Cal

16,000

Number of people who couldn't otherwise get private coverage because of pre-existing health conditions, but obtained insurance through a federally funded insurance pool for high-risk consumers

2 million

Approximate number of Californians who have received rebates from their insurance companies because of a provision limiting how much insurers could spend on administration, marketing and profits

Plus...

Millions of Californians are now getting preventive services with no out-of-pocket costs under a provision requiring private insurers to include it in policies sold since 2011.

Part 2 in a series

The eyes of the entire nation will soon be on President Barack Obama's Affordable Care Act, which takes full effect Jan. 1 with the requirement that nearly all Americans obtain health insurance or else pay a penalty on their taxes.

But many people probably don't know that much of the new law has actually been in place for nearly three years, and millions of Californians are already benefitting from its provisions.

Among the changes already here: an expanded public program for the poor; a high-risk insurance pool for people with pre-existing medical conditions; new benefits for seniors; and tougher insurance regulations. One of the most popular new rules was one of the first to take effect: requiring insurance companies to let adult children remain on their parents' policies through age 26.

Jamie Tremmel, 23, a student in her final year at UC Irvine School of Law, is one of those affected. Without the change, she would have faced the uncertainty of finding insurance coverage on her own until she could find a job that offered it. Now that's not a worry for at least three more years while she remains on her mother's policy with Kaiser Permanente.

“It's a relief,” Tremmel said in an interview. “Otherwise I might have had to go without insurance.”

While the provision that is helping Tremmel might be the best known, and possibly the most popular, of the Affordable Care Act's early changes, some of the others are affecting more people.

LOW-INCOME EXPANSION

A huge change has been the early expansion of coverage for low-income Californians. As part of what was known as the “Bridge to Reform,” the federal government paid for counties to expand eligibility to more than 700,000 people, mainly single adults with no children. In January these people and more will be part of an historic expansion of Medi-Cal. But many got their benefits early.

The head start helped community clinics like those run by in Orange County to begin treating a population that until recently had no coverage and only episodic care. The network has been expanding its facilities and adding new services, including pharmacies to serve patients on-site and staff to help them navigate the rules governing public assistance programs.

“A lot of people who haven't had insurance are going to be getting coverage and seeking services,” said Mildred Pena, who oversees the operation of six Orange County clinics for Los Angeles-based AltaMed. “We want to be able to serve them.”

Some of the other changes in the health care system already in place include:

The state, using federal money, created a new high-risk insurance pool for people who could not get coverage because of pre-existing health conditions. About 16,000 people took advantage of the program. As of Jan. 1, the pool will no longer be needed because the law forces insurance companies to sell to all those who apply, regardless of their health condition.

Insurance companies have issued about $74 million in rebates to nearly 2 million California customers because of a provision in the law that requires them to spend at least 80 percent of their premium revenue on health care rather than administration, marketing and profits.

All newly sold insurance policies must now offer preventive care with no out-of-pocket cost to the consumer. Millions of Californians are benefiting from that provision, though it has likely been financed by a small increase in everyone's monthly premiums.

Insurance companies can no longer cap the benefits a consumer can receive over his or her lifetime, a practice that used to mean that people with serious illnesses or accidents lost coverage just when they needed it most. An estimated 12 million Californians are benefiting from that additional measure of financial security.

Seniors and the disabled on Medicare have received rebates and are seeing prescription costs shrink thanks to a provision closing the “doughnut hole” in their coverage. More than 300,000 Californians are benefit- ing from the change.

FRONT-LOADED WITH POPULAR PROVISIONS

By design, Congress and Obama front-loaded the parts of the law that were likely to be most popular with consumers (and voters) while delaying the least popular – mandates and new taxes – until at least 2014. However, polls show that most people aren't even aware of the perks they or their family or friends have already gained under the law.

“There's so much talk about next year and all the things that will happen in 2014, that's where the focus has been, but especially in California, we already have so much in place,” said Anthony Wright, executive director of Health Access California, which is tracking the implementation of the health care overhaul.

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